- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,385.45 / $4,474.00 / $8,326.00
| Facility | | $1,385.45 | $4,474.00 | $8,326.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.49 / $914.75 / $9,399.87
| Facility | | $682.49 | $914.75 | $9,399.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.44 / $177.44 / $329.26
| Facility | AS | $177.44 | $177.44 | $329.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $7,205.00 / $11,396.00
| Facility | | $5,255.00 | $7,205.00 | $11,396.00 |